The Slow Road

Brad Cain, for HealthLeaders News , October 17, 2007

I wrote a cover story for HealthLeaders magazine earlier this year taking the pulse of the industry on the various healthcare reform ideas that were bouncing around state capitals across the nation. Massachusetts' recent success in passing a broad healthcare reform package along with the early enthusiasm for its implementation had leaders across the country looking for ways to cover more people in their own states.

One development in particular, the unveiling of wide-reaching plans by California Gov. Arnold Schwarzenegger and the leading Democrats in each branch of the Statehouse, seemed especially promising. During his time in office, Schwarzenegger has made it a habit of raising the profile of an issue and then championing it successfully either before the legislature or at the ballot box. And with so much public interest and industry support behind the issue of healthcare reform, it seemed like the time had arrived.

Well, nine months have passed and scant progress has been made in the Golden State.Early efforts at compromise failed, resulting in Assembly Speaker Fabian Nunez and Senate President Pro Tem Don Perata guiding their own proposal through the legislative process while Schwarzenegger stuck by the outline of his proposed reform plan. The resulting proposal from the Democrats--AB 8--would hold employers accountable for providing coverage (or pay into a state pool) and would expand access to the individual market as well as to public programs, among other changes.

The bill passed both houses of the Legislature, but was vetoed last week by Schwarzenegger because it failed to provide universal coverage, did not include a guarantee issue provision and placed too much of the financial burden on employers.

"California needs a financially sustainable healthcare reform plan that shares responsibility, covers all Californians and keeps our emergency rooms open and operating. I cannot support reform efforts that fall short of these goals and threaten to weaken our already broken system," Schwarzenegger wrote in his veto message, just days after releasing the specifics about his own proposed reforms.

Those details retain his call for an individual mandate for coverage but eased up on the level of commitment that would be required of employers.

Schwarzenegger called a special session of the legislature to address the healthcare reform issue and the parties say they are willing to talk. But the divide between the sides is much the same as it was back in January.

"We've worked hard on healthcare all year and are committed to finding a solution for the six and a half million uninsured in California and for working families whose costs are spiraling," Nunez wrote after AB 8 was rejected by Schwarzenegger. "This veto notwithstanding, where we end up on healthcare will have to look a lot like AB 8, particularly on affordability, fair participation from employers and keeping prescription drug costs down."

So is California back at square one? Not necessarily, but much time and momentum have already been lost.

Brad Cain is editor of California Healthfax and executive editor for managed care with HealthLeaders Media. He may be reached at .

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